Testicular Cancer Stages

After someone is diagnosed with testicular cancer, doctors will try to figure out if it has spread, and if so, how far. This process is called staging. The stage of a cancer describes how much cancer is in the body. It helps determine how serious the cancer is and how best to treat it. Doctors also use a cancer's stage when talking about survival statistics.

The earliest stage of testicular cancer is stage 0 (also called germ cell neoplasia in situ, or GCNIS). The other main stages range from I (1) through III (3). There is no stage IV (4) testicular cancer. Some stages are split further, using capital letters (A, B, etc.). 

As a rule, the lower the number, the less the cancer has spread. A higher number, such as stage III, means cancer has spread more. And within a stage, an earlier letter means a lower stage. Although each person’s cancer experience is unique, cancers with similar stages tend to have a similar outlook and are often treated in much the same way.

How is the stage determined?

The staging system most often used for testicular cancer is the American Joint Committee on Cancer (AJCC) TNM system, which is based on 4 key pieces of information:

  • The size and extent of the main tumor (T): How large is the tumor? Has it grown into nearby structures or organs?
  • The spread to nearby lymph nodes (N): Has the cancer spread to nearby lymph nodes? How large are they, and how many are affected?
  • The spread (metastasis) to distant sites (M): Has the cancer spread to distant parts of the body? (The most common sites of spread are distant lymph nodes, the bones, the liver, and the lungs.)
  • The serum (blood) levels of tumor markers (S): Are any tumor marker levels higher than normal? This includes lactate dehydrogenase (LDH), human chorionic gonadotropin (HCG), and alpha-fetoprotein (AFP).

Numbers or letters after T, N, M, and S provide more details about each of these factors. Higher numbers mean the cancer is more advanced. Once a person’s T, N, M, and S categories have been determined, this information is combined in a process called stage grouping to assign an overall stage. For more information, see Cancer Staging.

The system described below is the most recent AJCC system, effective as of January 2018. It is used for germ cell tumors (seminomas and non-seminomas) that occur after puberty, and for sex cord stromal tumors (Leydig cell tumors and Sertoli cell tumors).

Testicular cancer might be given a clinical T category (written as cT) based on the results of a physical exam, biopsy, and imaging tests (as described in How Is Testicular Cancer Diagnosed?). Once surgery is done, the pathologic T category (written as pT) is determined by examining tissue removed during the operation.

Testicular cancer staging can be complex, so ask your doctor to explain it to you in a way you understand.

Stages of testicular cancer

AJCC Stage

Stage grouping

Stage description*

0

pTis
N0
M0
S0

The cancer is only in the seminiferous tubules (small tubes inside each testicle). It has not grown into other parts of the testicle (pTis). It has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0). All tumor marker levels are within normal limits (S0).

I

pT1-pT4
N0
M0
SX

The tumor has grown beyond the seminiferous tubules, and might have grown outside of the testicle and into nearby structures (pT1-pT4). The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0). Tumor marker test results aren’t available, or the tests haven’t been done (SX).

IA

pT1
N0
M0
S0

The tumor has grown beyond the seminiferous tubules, but is still within the testicle, and it has not grown into nearby blood vessels or lymph nodes (pT1). The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0). All tumor marker levels are within normal limits (S0).

IB

pT2-pT4
N0
M0
S0

The tumor has grown outside of the testicle and into nearby structures (pT2-pT4). The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0). All tumor marker levels are within normal limits (S0).

IS

Any pT (or TX)
N0
M0

S1-S3

The tumor might or might not have grown outside of the testicle (any pT), or the extent of the tumor can’t be assessed for some reason (TX). The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0). At least one tumor marker level is higher than normal (S1-S3).

II

Any pT (or TX)
N1-N3
M0

SX

The tumor might or might not have grown outside of the testicle (any pT), or the extent of the tumor can’t be assessed for some reason (TX). The cancer has spread to one or more nearby lymph nodes (N1-N3), but it has not spread to distant parts of the body (M0). Tumor marker test results aren’t available, or the tests haven’t been done (SX).

IIA

Any pT (or TX)
N1
M0

S0 or S1

The tumor might or might not have grown outside of the testicle (any pT), or the extent of the tumor can’t be assessed for some reason (TX). The cancer has spread to at least one nearby lymph node (but no more than 5, if checked by surgery), and none of the lymph nodes are larger than 2 centimeters (cm) across (N1). The cancer has not spread to distant parts of the body (M0). All tumor marker levels are within normal limits (S0), or at least one tumor marker level is slightly higher than normal (S1).

IIB

Any pT (or TX)
N2
M0

S0 or S1

The tumor might or might not have grown outside of the testicle (any pT), or the extent of the tumor can’t be assessed for some reason (TX). The cancer has spread to at least one nearby lymph node that is larger than 2 cm but no larger than 5 cm across, OR it has grown outside of a lymph node, OR more than 5 nodes contain cancer (found during surgery) (N2). The cancer has not spread to distant parts of the body (M0). All tumor marker levels are within normal limits (S0), or at least one tumor marker level is slightly higher than normal (S1).

IIC

Any pT (or TX)
N3
M0

S0 or S1

The tumor might or might not have grown outside of the testicle (any pT), or the extent of the tumor can’t be assessed for some reason (TX). The cancer has spread to at least one nearby lymph node that is larger than 5 cm across (N3). The cancer has not spread to distant parts of the body (M0). All tumor marker levels are within normal limits (S0), or at least one tumor marker level is slightly higher than normal (S1).

III

Any pT (or TX)
Any N
M1

SX

The tumor might or might not have grown outside of the testicle (any pT), or the extent of the tumor can’t be assessed for some reason (TX). The cancer might or might not have spread to nearby lymph nodes (any N). It has spread to distant parts of the body (M1). Tumor marker test results aren’t available, or the tests haven’t been done (SX).

IIIA

Any pT (or TX)
Any N
M1a

S0 or S1

The tumor might or might not have grown outside of the testicle (any pT), or the extent of the tumor can’t be assessed for some reason (TX). The cancer might or might not have spread to nearby lymph nodes (any N). It has spread to distant lymph nodes or to the lungs (M1a). All tumor marker levels are within normal limits (S0), or at least one tumor marker level is slightly higher than normal (S1).

 

 

 

IIIB

 

Any pT (or TX)
N1-N3
M0

S2

The tumor might or might not have grown outside of the testicle (any pT), or the extent of the tumor can’t be assessed for some reason (TX). The cancer has spread to one or more nearby lymph nodes (N1-N3), but it has not spread to distant parts of the body (M0). At least one tumor marker level is significantly higher than normal (S2).

OR

Any pT (or TX)
Any N
M1a

S2

The tumor might or might not have grown outside of the testicle (any pT), or the extent of the tumor can’t be assessed for some reason (TX). The cancer might or might not have spread to nearby lymph nodes (any N). It has spread to distant lymph nodes or to the lungs (M1a). At least one tumor marker level is significantly higher than normal (S2).

 

 

IIIC

Any pT (or TX)
N1-N3
M0

S3

The tumor might or might not have grown outside of the testicle (any pT), or the extent of the tumor can’t be assessed for some reason (TX). The cancer has spread to one or more nearby lymph nodes (N1-N3), but it has not spread to distant parts of the body (M0). At least one tumor marker level is very high (S3).

OR

Any pT (or TX)
Any N
M1a

S3

The tumor might or might not have grown outside of the testicle (any pT), or the extent of the tumor can’t be assessed for some reason (TX). The cancer might or might not have spread to nearby lymph nodes (any N). It has spread to distant lymph nodes or to the lungs (M1a). At least one tumor marker level is very high (S3).

 OR

Any pT (or TX)
Any N
M1b

Any S

The tumor might or might not have grown outside of the testicle (any pT), or the extent of the tumor can’t be assessed for some reason (TX). The cancer might or might not have spread to nearby lymph nodes (any N). It has spread to distant parts of the body other than the lymph nodes or to the lungs (M1b). Tumor marker levels might or might not be higher than normal (any S).

 

*The following additional category is not listed on the table above: 

  • NX: Nearby lymph nodes cannot be assessed due to lack of information.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master's-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

American Joint Committee on Cancer. Testis. In: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer; 2017: 727-735.

Last Medical Review: December 19, 2017 Last Revised: December 19, 2017

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